HLA class I and class II polymorphism in the population of Rijeka, Croatia.

The aim of the study was to examine frequencies of HLA-A, -B, -DR antigens and haplotypes in population of Rijeka and to compare them with general Croatian and European populations. The subjects were 117 unrelated healthy blood donors. The antigens with the highest frequencies were: A2 (27.2%), A9 (16.3%), B5 (14.8%), B12 (11.8%), B18 (11.8%), DR5 (21.6%) and DR6 (13.8%). Comparison of HLA antigens frequencies has shown statistically significant difference in 1 antigen with Croatian population and in 8 antigens with European population. The HLA haplotypes with high frequencies included HLA-A2, B5 (6.84%), HLA-A2, B12 (6.84%), HLA-A2, B18 (6.84%), HLA-B12, DR2 (9.78%) and HLA-B18, DR5 (6.84%). The antigen B5 showed strongest association with DR5 (6.41%; LD = 1.30) as in general Croatian and in some European populations. The results have shown great diversity of HLA haplotypes in Rijeka population which can be the result of admixture with neighborhood immigrating populations during the history.

Prospective evaluation of pretransplant blood transfusions in cadaver kidney recipients.

BACKGROUND: A beneficial effect of pretransplant transfusions on graft survival was demonstrated in the early 1970s. In the mid-1980s, however, retrospective studies showed that transfusions had lost their graft-protective effect in the cyclosporine era. During the last 10 years, deliberate transfusion pretreatment of transplant patients has been discontinued. METHODS: Within a collaborative project of 14 transplant centers, prospective recipients of cadaver kidney grafts were randomized to receive either three pretransplant transfusions or transplants without transfusions. RESULTS; The graft survival rate was significantly higher in the 205 transfusion recipients than in the 218 patients who did not receive transfusions (at 1 year: 90+/-2% vs. 82+/-3%, P=0.020; at 5 years: 79+/-3% vs. 70+/-4%, P=0.025). Cox regression analysis showed that this effect was independent of age, gender, underlying disease, prophylaxis with antilymphocyte antibodies, and preformed lymphocytotoxins. CONCLUSIONS; Transfusion pretreatment improves the outcome of cadaver kidney transplants even with the use of modern immunosuppressive regimens.

Organ transplantation at the Rijeka Clinical Medical Center--from kidney to pancreas.

From January 1971 to January 1994 the authors performed 560 kidney, and two simultaneous pancreas and kidney, transplantations at the Rijeka Clinical Medical Center. Three hundred and nine kidneys (55%) were from a related living donor (two from unrelated living donors), while 253 (45%) kidney and two pancreas grafts were from cadaveric donors. Analyzing the mean patients' age at the time of transplantation the authors noticed its steady increase over five-year periods, a decrease of chronic glomerulonephritis from 76% to 60%, and a gradual increase in diabetic nephropathy from 0 to 6%. Cumulative 1- and 5-year patient survival rates after living donor transplants including conventional immunosuppression were 95 and 83%, respectively; with Cs the survival rates were 94% and 90% (N. S.). For living donor kidney grafts the 1- and 5-year survival rates with conventional immunosuppression were 76% and 50%, respectively. With Cs the survival rates were considerably higher: 88% after 1 year and 71% after 5 years (p < 0.01). Cumulative survival rates of patients with cadaveric transplants receiving conventional immunosuppression were 82% and 71%, respectively; with Cs they were 87% and 78% (N.S.). The survival rate of cadaveric transplants was 51% after one year and 38% after five years in the first period, but it improved significantly after introduction of Cs. increasing to 81% and 52%, respectively (p < 0.001). Renal transplantation in diabetics does not preclude the recurrence of diabetic nephropathy in the graft; successful pancreas and kidney transplantation does, however, and thus offers the patient a better quality of life.

[Quality control of frozen plasma in 8 blood transfusion centers in the Croatian Republic]. / Kontrola svjeze smrznute plazme u 8 transfuzijskih ustanova u republici Hrvatskoj.

Fresh frozen plasma (FFP) is one of the most frequently used blood components. Its use is continuously increasing, although 50 to 80% of units are not used according to the approved indications. The quality control of FFP was performed in 6 blood transfusion centers. The volume of FFP unit was between 178 and 234 ml. F VIII: C above 0.70 i. u./ml was observed in 40.9 of units. Plasma in 0.9% of units was not sterile and the concentration of total proteins and hemoglobin were within the acceptable range.

[Quality control of erythrocyte concentrates in 6 transfusion centers in Croatia]. / Kontrola kvalitete eritrocitnih koncentrata u sest transfuzioloskih ustanova u SR Hrvatskoj.

Quality control of red cell concentrates (RCC) was performed in six Blood Transfusion Centres in Croatia. Between 1.5 and 3.7% of the produced or/and used RCC were examined. Large differences in volume and haematocrit were found between red cell concentrates. 63.2% of concentrates had a volume larger than 225 ml. The mean haematocrit was 65.5%, and a haematocrit above 65% was observed in 51.6% of RCC. From 3.5% of RCC bacteria were isolated (gram positive coccus, Staphylococcus albus, Staphylococcus epidermidis and Streptococcus haemolyticus). The quality of RCC was not found to be satisfactory. In order to improve their quality procedures for their production, standards and legal requirements have to be established.

[Acute renal failure following necrosis of a myoma in the puerperium]. / Akutno zatajenje bubrega nakon nekroze mioma u puerperiju.

The case is presented of a 36-year-old secundipara with the uterine myoma and a mild form of EPH gestosis. She became icteric and anuric on the sixth day after a spontaneous vaginal delivery and an apparently uneventful early puerperium. Blood coagulation tests were characteristic of disseminated intravascular coagulation (DIC). Since it is postulated that the appearance of DIC could be connected with the probable necrosis of a preexisting uterine myoma, abdominal hysterectomy was performed on the 8th puerperal day. Because of a persisting acute renal failure with highly elevated BUN levels and creatinine, the patient was subjected to haemodialysis every day during the next 73 days. After 3 months of this treatment she was discharged from hospital with a reduced but satisfactory renal function. The pathogenesis of DIC and acute renal failure following necrosis of the uterine myoma is discussed.

[Renal transplantation--a possible factor in the development of circulatory insufficiency in the lower extremities]. / Renalni transplantat--moguci faktor u razvoju cirkulatorne insuficijencije donjih ekstremiteta.

The major subjects of this presentation are: 1. Angiological aspects of living and cadaveric transplant donor; 2. The possibilities and importance of angiosurgical procedures during the transplantation operation; 3. Vascular complications of kidney transplantation; 4. Occlusive arterial diseases and the possibilities of treatment. The experiences after 423 renal transplantations have been overviewed and special problems of interest commented.

[A case report of prolonged hemolytic anemia in an infant due to a partial exchange transfusion]. / Prikaz slucaja protrahirane hemolizne anemije dojenceta zbog djelomicne ekssangvinotransfuzije.

An infant at the age of one month was admitted to hospital due to anaemia and icterus. Premature delivery was induced because of Rh immunisation. Newborn's grave condition permitted only one "blood volume" exchange transfusion and as a consequence prolonged haemolytic anaemia occurred. At the age of one month anti Rh-D antibody persisted in the infant circulation with the titre 1:16 in an indirect antiglobulin method.

[Case report of congenital deficiency of factor V and factor VIII]. / Prikaz slucaja kongenitalnog deficita F V i F VIII.

A case of a rare congenital combined deficiency of factor V (14%) and factor VIII (30%) is described for the first time in our literature. Nine years old girl was admitted to hospital because of nightly bleedings from hyperplastic and inflamed gums. Clinical picture was mild what is in accordance with the results of coagulation studies. Under substitution therapy tooth extraction passed without complications.

[Determination of the blood group, Rh-D factor, and indirect Coombs' test using the amniotic fluid]. / Odredivanje krvne grupe, Rh-D faktora i indirektnog Coombsova testa iz plodne vode.

The number of Rh-D sensibilizations provided by pregnancy and delivery has decreased as the result of the preventive measures introduced to the combat this condition. The problem, however, still exists, and to cope with it, the determination of the blood group, Rh-D factor, and the Coombs' test using the amnionic fluid allows a timely preparation for the therapy of the newborn's hemolytic disease. The method of the neutralization technique employed by the authors has proved reliable.